主观认知下降与阿尔茨海默病临床特点差异和影响因素初步分析  

Clinical differences between subjective cognitive decline and Alzheimer’s disease and related influencing factors

作　　者：李汶逸 姜季委 王琳琳[1] 张源 任琦玮 王艳丽 贾紫嫣 孙梦凡 徐俊 Li Wenyi;Jiang Jiwei;Wang Linlin;Zhang Yuan;Ren Qiwei;Wang Yanli;Jia Ziyan;Sun Mengfan;Xu Jun(Department of Cognitive Disorders,National Clinical Research Center for Neurological Diseases,Centerfor Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心认知障碍性疾病科、国家神经系统疾病临床医学研究中心,100070

出　　处：《中华老年心脑血管病杂志》2023年第8期797-800,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(82071187,81870821);国家重点研发计划项目(2021YFC2500100,2021YFC2500103)。

摘　　要：目的比较主观认知下降(SCD)与阿尔茨海默病(AD)患者临床特点差异和相关影响因素。方法连续收集2021年10月至2022年10月首都医科大学附属北京天坛医院收治的AD生物标志物与生活方式研究队列的AD患者105例(AD组),SCD患者51例(SCD组)。采用单因素分析比较2组基线资料、精神行为症状(BPSD)、蒙特利尔认知评估量表(MoCA)评分、日常生活活动能力量表评分以及载脂蛋白E(apoE)基因的差异,采用多因素logistic回归分析SCD患者发生AD可能的影响因素。结果AD组年龄、BPSD、携带apoEε4比例明显高于SCD组[(70.30±8.64)岁vs(65.67±6.86)岁,P<0.01;77.1%vs 27.5%,P<0.01;41.9%vs 17.6%,P<0.01],受教育程度初中及以上、适当摄入咖啡及MoCA评分明显低于SCD组[78.1%vs 92.2%,P<0.05;11.4%vs 29.4%,P<0.01;12.0(6.0,15.0)分vs 26.0(24.0,27.0)分,P<0.01]。多因素logistic回归分析显示,BPSD(OR=7.970,95%CI:3.167~20.054,P=0.001)、携带apoEε4(OR=2.742,95%CI:1.084~6.935,P=0.033)是SCD发生AD的危险因素,而受教育程度为初中及以上(OR=0.229,95%CI:0.060~0.878,P=0.032)、适当摄入咖啡(OR=0.306,95%CI:0.104~0.892,P=0.030)是SCD发生AD的保护因素。结论有BPSD及携带apoEε4的SCD患者发生AD风险升高,受教育程度初中及以上、适当摄入咖啡的SCD患者发生AD风险降低。Objective To compare the clinical characteristics between the patients with subjective cognitive decline(SCD)and those with Alzheimer's disease(AD),and analyze the related influencing factors.Methods A total of 105 AD patients and 51 patients with SCD of the AD Biomarker and Lifestyle Study Cohort at Beijing Tiantan Hospital Affiliated to Capital Medical University were consecutively enrolled from October 2021 to October 2022.Univariate analysis was used to compare the baseline data,behavioral psychiatric symptoms(BPSD),Montreal cognitive assessment scale(MoCA)scores,activities of daily living scores and the difference of apolipoprotein(apoE)gene between the two groups.Multivariate logistic regression analysis was adopted to further analyze the influencing factors.Results Older age(70.30±8.64 years vs 65.67±6.86 years,P<0.01),higher ratios of BPSD(77.1%vs 27.5%,P<0.01)and carrying apoEε4(41.9%vs 17.6%,P<0.01)were observed in the AD group than the SCD group.And the AD group had lower proportions of education level of junior high school or above(78.1%vs 92.2%,P<0.05)and appropriate coffee consumption(11.4%vs 29.4%,P<0.01),and reduced MoCA score[12.0(6.0,15.0)vs 26.0(24.0,27.0),P<0.01]than the SCD group.Multivariate logistic regression analysis showed that the frequency of BPSD(OR=7.970,95%CI:3.167-20.054,P=0.001)and carrying apoEε4(OR=2.742,95%CI:1.084-6.935,P=0.033)were risk factors for the progression of SCD to AD,and education level of junior high school or above(OR=0.229,95%CI:0.060-0.878,P=0.032)and appropriate coffee consumption(OR=0.306,95%CI:0.104-0.892,P=0.030)were protective factors.Conclusion The risk of AD is increased in SCD patients with BPSD and carrying apoEε4,and the risk is decreased in those with education level of junior high school or above and appropriate coffee consumption.

关 键 词：阿尔茨海默病 认知功能障碍 影响因素分析 降低风险行为 精神状态和痴呆测验 载脂蛋白E基因 

分 类 号：R749.16[医药卫生—神经病学与精神病学]